Traction Neurectomy for Treatment of Painful Residual Limb Neuroma in Lower Extremity Amputees.
Abstract
OBJECTIVES:
To describe the outcomes of traction neurectomy as a surgical treatment for symptomatic neuroma of the residual lower extremity, and to identify clinical and/or demographic factors associated with an increased likelihood of persistent or recurrent pain after surgery.
DESIGN:
Retrospective Cohort Study SETTING:: Amputee clinic at a Level I Trauma Center PATIENTS:: Inclusion required a history of transfemoral or transtibial amputation, and a history of symptomatic neuroma(s) at the residual limb treated with traction neurectomy. 12 months of clinical follow-up OR the recurrence of neuroma-type pains was required for inclusion. 38 patients (63 nerves) comprised the study group.
INTERVENTION:
Traction neurectomy for treatment of symptomatic neuroma MAIN OUTCOME MEASURES:: The primary outcome was the presence or absence of persistent or recurrent neuroma-type pain at last follow-up. The secondary outcome was reoperation for persistent or recurrent symptomatic neuroma.
RESULTS:
16 of 38 patients (42%) had recurrent or persistent neuroma-type pain at a mean follow-up of 37 months (range, 11-91 months), and 8/38 (21%) have undergone subsequent surgical treatment. Among the demographic and clinical features examined, only male gender was found to be a statistically significant predictor of persistent or recurrent neuroma-type pain.
CONCLUSIONS:
Traction neurectomy results in a high rate of persistent or recurrent neuroma-type and that surgeons should be cautious when considering it for the treatment of symptomatic neuroma of the residual lower extremity. Furthermore, efforts to identify better surgical and non-surgical treatments for this problem are justified.
LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
- PMID:
- 25875175
- [PubMed - as supplied by publisher]
No comments:
Post a Comment